Introduction
Recent developments in drug therapy have improved the disease activity
of rheumatoid arthritis (RA). These developments include the
administration of conventional synthetic disease-modifying
anti-rheumatic drugs (DMARDs), biological DMARDs, and targeted synthetic
DMARDs.1 However, the progression of joint destruction
in the lower extremities remains a major problem in clinical
settings.2
In previous reports, the incidence of ankle involvement in joint
destruction ranged from 4% to 90%.3–6 In the Korean
registry, 29% (598/2046) of patients with RA had foot and/or ankle
arthritis, with greater severity of disease activity and lower remission
rate compared with those without foot and/or ankle
RA.6 In the United Kingdom registry, 35.4% (207/585)
of patients reported current foot pain as the presenting
symptom.4 Most studies report a high prevalence of
foot and ankle involvement in patients with RA. Yano et al. reported
that patients with RA and foot impairment had higher disease activity
and lower activities of daily living than those without foot
impairment.7
The elderly population with RA includes both patients with elderly-onset
RA (EORA), in which the disease manifests after the age of 60 years, and
individuals diagnosed with RA early in life (young-onset RA or YORA).
There are treatment concerns for the older adult population group, as RA
drugs can induce several age-related adverse events.8In addition, the reversibility of functional impairments is reduced in
older patients with RA due to age-related factors or
comorbidities.9
In the KURAMA cohort (a Japanese cohort of patients with RA), patients
with EORA showed higher bone erosion than patients with
YORA.10 Furthermore, complaints of ankle deformity and
functional disability were higher in patients with EORA.
When ankles are deformed by RA, both the talocrural and subtalar joints
are damaged, and ankle arthrodesis using a retrograde intramedullary
ankle nail is the surgical procedure of choice.11−16
Here, we present two cases of patients with RA who presented with highly
destructive changes in the ankle joint. We performed retrograde
intramedullary nail fixation surgery in both patients, which resulted in
good functional outcomes.